The Practice of Mental Health Nurse: Impact of Social, Political and Economic Factors - Case Study Example

Practice of Mental Health Nurse: Impact of Social, Political and Economic Factors Introduction Mental health is defined by the WHO as "a of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". It is necessary for the well being and effective functioning for an individual and for a community. It can be said that mental, physical, and social functioning are interdependent. There are multiple social, psychological and biological factors interacting to determine health (WHO Summary Report, 2004). Nurses play a major role in the assessment and treatment of mental health patients. Nurses, by virtue of their proximity to the patients develop a sense of empathy and caring feeling which comes naturally to them and thus are able to promote the emotional well being of the patient. Mental health nurses work with people suffering from various types of mental illnesses. Besides the knowledge of the mental diseases and treatments, to pursue their functions efficiently, it is important for the mental health nurses to understand the various factors which influence mental health of people. Such an understanding can be developed by studying the case of 69 year of Linda who suffers from Paranoid Schizophrenia. Role of economic factors Economically, Linda is a dependent person, that too on abusive husband. She also lives on DLA benefits. Poverty and deprivation have a significant effect on mental health. Poor people in any society are vulnerable to mental illness because of insecurity, hopelessness, rapid social change, risks of physical and mental abuse and increased physical morbidity (WHO Summary Report, 2004). The association between poverty and mental illness is universal. It occurs in all societies whether, developed, under developed or developing. According to World Health Organization, "Mental disorders occur in persons of all genders, ages, and backgrounds. No group is immune to mental disorders, but the risk is higher among the poor, homeless, the unemployed and persons with low education" (Cited in Kuruvilla & Jacob, 2007). Poverty is associated with lack of opportunity, reduced availability and accessibility to resources and increased chances of experiencing difficult events. These can lead to distress which can manifest as low mood, sadness, frustration, discontentment or physical illness without organic cause (Kuruvilla & Jacob, 2007). Common mental disorders like anxiety and depression are prevalent more commonly amongst the lower social economic group, especially those with the lowest material standard of living (Kuruvilla & Jacob, 2007). The factors which contribute to these manifestations are financial hardship, lower education, unemployment, stress, and unfulfilled ambitions expectations at work (Manoranjitham, 2005). Linda is from a hard financial background, she is not properly educated has have communication difficulties. She is in a sheltered accommodation. These factors not only contribute to mental illness, but also influence the treatment aspects. Psychiatric illness also leads to poverty. This can be explained by the drift hypothesis. According to this hypothesis, psychiatric illness can result in deterioration in functioning to such an extent that the affected individual is drifted down to the lower socio-economic status. Drifting is most commonly seen in schizophrenia when compared to other psychiatric illnesses. Goldberg & Morrison (1963) reported that schizophrenia affected the economic status of the persons affected. Also to consider is the fact that mental illnesses pose a heavy financial burden on individuals, their families, society, community and nation. This can be either due to expenditure for medications, consultations, in-hospital admissions or any other form of utilization of health services. Medications constitute an important source of expenditure because most of the patients with mental disorders need long -term medication, many of which may not be covered by insurance companies. In some developing countries like India (Punjab), the poor do not have health insurances. Long term medications can also lead to side effects like elevated lipids and sugar which may further increase the cost of treatment (Kuruvilla & Jacob, 2007). Major psychiatric conditions like schizophrenia and mood disorders are at risk for physical disability due to poor lifestyle and self-neglect as is the case of Linda. Treatment of these physical conditions further adds up to the cost (Kuruvilla & Jacob, 2007). Role of social factors All forms of medical care including mental health involve interaction between two or more people and hence an understanding of how social factors influence treatment will assist the nurse in developing skills. Social factors affecting mental health in Linda are minority status in UK, dependency on abusive husband, life of dependency on benefits, living in sheltered accommodation and inability to communicate properly because of lack of spoken English. In mental illness, social factors play an important role in a persons decision to seek treatment (Goldman, 2000). Major mental disorders like schizophrenia, bipolar disorder, depression, and panic disorder are found world wide with no racial, ethnic or traditional barriers. Some of the social factors implicated in the development of mental disorders are decreased availability of mental health services, decreased access to mental health services, poorer quality of mental health care, under-representation in mental health research and barriers deterring minorities from reaching treatment (Surgeon General Report, 1999). Some of the barriers include, cost involved in the treatment, fragmentation of services, societal stigma toward mental illness, mistrust and fear of treatment, racism and discrimination and differences in language and communication (Surgeon General Report 1999). Minorities do not trust mental health services. They suspect clinician bias and stereotyping (Surgeon General Report 1999). Suicidal tendencies are more common in white race (Bhalla 2006) and infact, depression is less common in the black population (Bhalla 2006). In bipolar disease, no racial predilection exists (Soreff, 2007) It is important for the nurse to know these aspects so that these individuals can be seriously addressed and any disparities encountered in the treatment can be remedied. Communication is an important aspect of health care because mental disorders affect thoughts, moods, and the highest integrative aspects of behavior, and diagnosis and treatment of these mental disorders is largely dependent on communication and trust between the patient and the health professional (Surgeon General Report 1999). Culture, race, ethnicity and society have wide-ranging roles in mental health, mental illness, and mental health services. Culture influences the way the patients elaborate their symptoms and which symptoms they consider as important reporting. It is important to understand these aspects so that services that are specific to the needs of the racial and ethnic minorities can be provided. Culture influences the way the patients elaborate their symptoms and which symptoms they consider as important reporting. Asian patients like Linda are likely to express psychological distress as physical complaints (Kramer, 2002). Culture also influences help seeking behavior of the affected individual, what types of help they seek, their coping styles, the social support they get and the social stigma attached to the mental disorder. A person diagnosed with mental illness may be distanced socially (Lauber, 2004). Each culture has its own style of coping with disorders which buffers some people from developing certain disorders. Cultural norms not only affect the way patients present with symptoms, they also affect the way a health professional views the symptoms of the patient. There can be difference in the views of the patient and the health professional which may affect the delivery of care, diagnosis of the condition, treatment instituted and organization and reimbursement of services. It is obvious that health professionals who are much influenced by these cultural norms and who are not aware of the patients cultural requirements and variations can not do a good job of health care provision (Surgeon General Report, 1999). In Linda, some of the negative aspects of social factors which influences treatment is lack of proper social network, no friends, lack of communication, self-isolation, vulnerability due to age and mental health problem. Cultural factors have a lot of influence on the DSM categories and also on the assessment and diagnosis of clinical disorders. This is because individuals of poor communities and culturally diverse populations like Linda are exposed to a multiplicity of physical, social and psychological stressors. Many a times, individuals from such populations indicate behaviors that do not meet any one diagnosis but whose severity demand therapeutic intervention (Canino, 2000). Mental health nurses should be aware of these aspects because other times these individuals behaviors are solely a reflection of the exposure to continuously environmental stressors and hence the diagnosis of a condition must be reserved for unresponsive political and social interactions (Canino, 2000). Culture serves as the nexus of counseling practice and as a fundamental theoretical construct in understanding the change process (Douthit, 2006). Political factors influence on mental health Like other health reforms, mental health is also associated with the way health system works. This includes rules of governments, health professionals and the lay public. Frankish et al (2002) studied the effects of political factors on health reforms in British Columbia, Canada. They opined that the qualifications, representation and selection of the health board members influence health reforms. Also, relationship and addressing the concerns of the stake holders has an influence on the implementation of health reforms. There is a disparity in state and federal programs with many areas underserved (Community Alliance, 2009). In some countries, there are no Mental Health Hospitals. The patients are admitted in general hospitals. There are also severely mentally disabled persons who are homeless and not taken care of, living on the streets, surviving from garbage can to garbage can (Community Alliance, 2009). Many benefits either financially or resources are provided for the health professionals dealing with physical ailments. Such encouragement is not seen much in mental health care services. Increased financial support in the form of increased ancillary staff salary, post-graduate allowance for general practitioners and medical reimbursement can enhance participation of health professionals in mental health services and increase quality of mental health services. In the long term, such changes can benefit mental health arena even among those currently not interested in mental health work. Preventive services in mental health can be enhanced by more collaborative work practices, decisions on priorities for the team, close monitoring of the health and health needs of the client group and measures of their effectiveness (Newton, 1994). There are many challenges encountered by the health professionals in the mental health and drug-abuse management faculty (Jones, 2003). One important stress factor is inadequate practical experience. Though the nurses are trained academically, they may not have real-life experience, making them more vulnerable to stress. Also, many de-addiction centers and mental health services do not have adequate staff because working in these units is highly demanding with fewer pay packets. Added to this, most of these services rendered are through government or non-profit making organizations and hence may not be funded appropriately. Also, of concern is the patient behavior. The kind patients who come to these units have a wide range of mental problems and hence their behavior will be abnormal. Some may turn violent and others may use abusive language (Room, 2005). Another issue faced by the nurses is lack of resources (Annette, 2004). This is usually a problem in remote and rural areas. Due to the high stressful conditions which drains the nurses physically and mentally, the nurses themselves may go in for alcohol, anti-anxiety medications, etc. Some may develop depression. As such the staff themselves may require counseling and help (Happell, 1999). Gender and mental health It is important to understand the gender related demographics of mental health disorders so as to arrive at a correct diagnosis, assist appropriate treatment and take help of other organizations like medical and legal if necessary. In the demographic study on Community Alliance (Community Alliance, 2009), it has been estimated that the overall incidence of mental health disorders is similar among men and women, however, there does exist a difference in different diagnoses. Women are often at greater risk of mental ailments because of the multiple roles they fulfill in society and the stress they are prone to because of their roles. Women also are at the receiving end of not only gender discrimination and the associated factors of poverty, hunger, malnutrition and overwork, but also of sexual and domestic violence (WHO Media Center, 2000). Women are most likely to be affected by anxiety related disorders and depression (Tao et al, 2002). The lifetime risk of schizophrenia is equal for both sexes. However, the onset is earlier and the outcome is poorer in males than in females. Females have a better response than males to antipsychotic medications (Gerstein, 2007). To provide appropriate service to womens mental health needs, it is important to understand the different factors which influence womens mental health. Women suffer more from hopelessness, lack of education, insufficient employment and non-cooperation from family members. They are targets of social stigmas and beliefs (Kuruvilla & Jacob 2007). Women also suffer from physiological depression due to menstruation, pregnancy and lactation. Conclusion Mental health is affected by various sociological, economical and political factors, all of which are actually interdependent. Understanding these aspects helps a mental health nurse focus on certain underprivileged groups, retrieve information about despair, arrive at proper diagnosis, assess outcomes and arrange for other sources of help. References Annette, M., Nkowane, R.N., & Saxena, S. (2004). Opportunities for an improved role for nurses in psychoactive substance use: Review of the literature. International Journal of Nursing Practice, 10 (3), p.102–110. Bhalla, R.N. (2006). Depression. eMedicine from WebMD. Retrieved on 29th November, 2009 from http://www.emedicine.com/med/topic532.htm. Canino, I. A., & Spurlock, J. (2000). Culturally Diverse Children and Adolescents: Assessment, Diagnosis, and Treatment. (2nd ed.). New York: Guilford Press. Community Alliance. Mental disabilities. Retrieved on 29th November, 2009 from http://medicine.creighton.edu/IDC242/2005/Group7/links.htm [accessed 2 December 2007] Douthit, K.Z. (2006). 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